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Background <p>Hospital malnutrition is associated with adverse clinical outcomes, yet real-world evidence distinguishing nutritional risk screening from diagnostic assessment remains limited. This study evaluated a stepwise NRS2002-based screening and assessment pathway and examined associations between pathway-defined malnutrition and clinical outcomes in hospitalized patients.</p> Methods <p>This retrospective cohort study was conducted at Xishan People’s Hospital from January 2022 to June 2025. Adult patients admitted for &gt; = 24&#xa0;h who completed Nutritional Risk Screening 2002 (NRS2002) within 48&#xa0;h were included. NRS2002 was the universal screening tool. Patients with NRS2002 &gt; = 3 underwent diagnostic assessment according to a predefined decision tree: oncology patients received Patient-Generated Subjective Global Assessment (PG-SGA), non-oncology patients with BMI &lt; 18.5&#xa0;kg/m2 received Global Leadership Initiative on Malnutrition (GLIM) evaluation, and remaining at-risk patients received Subjective Global Assessment (SGA). Primary outcomes included hospital-acquired infection (HAI), 30-day readmission among discharged-alive patients, and in-hospital mortality.</p> Results <p>Among 2,856 patients (mean age 59.23 +/- 15.47 years; 52.17% male), 1,187 (41.56%) were identified as at nutritional risk by NRS2002. Three pathway groups were identified: NRS2002 &lt; 3 (<i>n</i> = 1,669), NRS2002 &gt; = 3 but not malnourished (<i>n</i> = 335), and malnourished (<i>n</i> = 852). The pathway-defined malnutrition proportion was 29.83% in the total cohort and 71.78% among NRS-positive patients. Malnourished patients had higher rates of HAI (14.67% vs. 5.29%; <i>P</i> &lt; 0.001), 30-day readmission among discharged-alive patients (20.84% vs. 11.18%; <i>P</i> &lt; 0.001), and in-hospital mortality (8.22% vs. 2.30%; <i>P</i> &lt; 0.001). In multivariable models, malnutrition was associated with HAI (aOR = 2.19; 95% CI: 1.57–3.07), 30-day readmission among discharged-alive patients (aOR = 1.81; 95% CI: 1.38–2.37), and in-hospital mortality (aOR = 2.54; 95% CI: 1.59–4.04).</p> Conclusions <p>In this single-center retrospective cohort, malnutrition identified through a stepwise NRS2002-based assessment pathway was common and was associated with higher HAI, readmission, mortality, and length of stay. HIS-integrated nutrition software may support standardized documentation and workflow efficiency, but the present observational study did not directly evaluate software effectiveness or interventional care pathways.</p>

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Prevalence and clinical outcomes of malnutrition in hospitalized patients: a real-world study using a stepwise screening-assessment pathway

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  • 发表日期：

    2026年8月1日

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  • Qunfang Hua,
  • Yang Yu,
  • Yun Feng

摘要

Background

Hospital malnutrition is associated with adverse clinical outcomes, yet real-world evidence distinguishing nutritional risk screening from diagnostic assessment remains limited. This study evaluated a stepwise NRS2002-based screening and assessment pathway and examined associations between pathway-defined malnutrition and clinical outcomes in hospitalized patients.

Methods

This retrospective cohort study was conducted at Xishan People’s Hospital from January 2022 to June 2025. Adult patients admitted for > = 24 h who completed Nutritional Risk Screening 2002 (NRS2002) within 48 h were included. NRS2002 was the universal screening tool. Patients with NRS2002 > = 3 underwent diagnostic assessment according to a predefined decision tree: oncology patients received Patient-Generated Subjective Global Assessment (PG-SGA), non-oncology patients with BMI < 18.5 kg/m2 received Global Leadership Initiative on Malnutrition (GLIM) evaluation, and remaining at-risk patients received Subjective Global Assessment (SGA). Primary outcomes included hospital-acquired infection (HAI), 30-day readmission among discharged-alive patients, and in-hospital mortality.

Results

Among 2,856 patients (mean age 59.23 +/- 15.47 years; 52.17% male), 1,187 (41.56%) were identified as at nutritional risk by NRS2002. Three pathway groups were identified: NRS2002 < 3 (n = 1,669), NRS2002 > = 3 but not malnourished (n = 335), and malnourished (n = 852). The pathway-defined malnutrition proportion was 29.83% in the total cohort and 71.78% among NRS-positive patients. Malnourished patients had higher rates of HAI (14.67% vs. 5.29%; P < 0.001), 30-day readmission among discharged-alive patients (20.84% vs. 11.18%; P < 0.001), and in-hospital mortality (8.22% vs. 2.30%; P < 0.001). In multivariable models, malnutrition was associated with HAI (aOR = 2.19; 95% CI: 1.57–3.07), 30-day readmission among discharged-alive patients (aOR = 1.81; 95% CI: 1.38–2.37), and in-hospital mortality (aOR = 2.54; 95% CI: 1.59–4.04).

Conclusions

In this single-center retrospective cohort, malnutrition identified through a stepwise NRS2002-based assessment pathway was common and was associated with higher HAI, readmission, mortality, and length of stay. HIS-integrated nutrition software may support standardized documentation and workflow efficiency, but the present observational study did not directly evaluate software effectiveness or interventional care pathways.